Infections of the upper respiratory tract in cases of sudden infant death

Kleemann, W. J.; Hiller, A. S.; Tröger, H.

doi:10.1007/bf01369910

Cited by 27 publications

(12 citation statements)

References 21 publications

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“…3 Meadow has long recognised the problem of smothering as a component of Munchausen's syndrome by proxy (MSBP), 4 although he has concentrated upon critically reviewing the histories of such deaths. His observations have been supported by those of Byard et al 5 Reports on the pathology of SIDS [6][7][8][9][10][11] observe that some degree of intra-alveolar haemorrhage is common in these cases. Grellner and Madea 12 noted that intra-alveolar haemorrhage was common in asphyxial deaths.…”

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confidence: 57%

Intra-alveolar haemorrhage in sudden infant death syndrome: a cause for concern?

et al. 1999

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Background-The "Back to Sleep" campaign in 1991 resulted in a dramatic decrease in the incidence of sudden infant death syndrome (SIDS). The proportion of presumed SIDS deaths being actually suspicious deaths from airway obstruction is likely to have become relatively greater. There is usually little pathological evidence to suggest smothering, but intraalveolar haemorrhage appears to be more prominent in cases where interference with the airway is suspected. Aim-To attempt to quantify intraalveolar haemorrhage to see whether it could be used as a marker to distinguish between smothering/overlaying and SIDS. Methods-Intra-alveolar haemorrhage was quantified using digital image analysis on haematoxylin/eosin stained sections taken from the lungs of 62 consecutive infants who had died suddenly and unexpectedly. Cases were initially classified according to the original cause of death. After quantitation, the case histories were critically reviewed. Three pathologists independently made microscopic assessments of the degree of intra-alveolar haemorrhage in the first 24 cases to see whether these accurately reflected the quantitative results. Results-73% of those infants with a history suggesting possible involuntary overlaying and 45% of those with a history suspicious of smothering had significant intra-alveolar haemorrhage (> 5% of total lung surface area assessed). From the history, the cause of death in 11 cases initially classified as SIDS would better have been given as "Unascertained." Simple microscopic assessments underestimated the true extent of the haemorrhage in 33% (8/24). Conclusions-If a moderate degree (at least 5%) of pulmonary parenchymal haemorrhage is observed, this may be an indicator of airway obstruction for a significant period, either from overlaying or possibly smothering. The diagnosis of SIDS may be being used inappropriately in such cases. (J Clin Pathol 1999;52:581-587)

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confidence: 57%

Intra-alveolar haemorrhage in sudden infant death syndrome: a cause for concern?

et al. 1999

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“…It must be supposed that not only foudroyant infection may precede a measurable immune response [33]. Also minor inflammatory changes in "typical SIDS cases" seem to be characterized by detectable immune response and may contribute to some cot deaths [34,35].…”

Section: Discussionmentioning

confidence: 99%

Reaction patterns in selected lymphatic tissues associated with sudden infant death (SID)

Bajanowski

Ortmann

Hernández

et al. 1997

International Journal of Legal Medicine

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In 50 cases of sudden infant death cervical, paratracheal and lung hilar lymph nodes, the thymus and the spleen were investigated by histology and immunohistochemistry (CD 20, 21, 45RO). The cases were divided into 3 groups based on autopsy findings including extensive histology: A --without pathological changes (N = 12), B --with minimal to intermediate inflammation (N = 23) and C --with severe inflammation (N = 15). In accordance with previous results the frequency of "pathological" lymph node changes, such as paracortical lymphoid hyperplasia and variegated hyperplasia of the pulp increased from group A to group C. The B-cell antigens reacted accordingly. A pronounced lymphodepletation of the thymus as a sign of a long lasting stimulation of the T-cell system was also observed increasingly from group A to C. In summary, in none of the cases results obtained were indicative of a defect of the T- or B-cell system. The results in group A seem to indicate that changes in the reaction pattern of the lymphoid tissues could be a more sensitive method of detection of early stages of inflammation than local histology.

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“…The concept of infections as a factor in SIDS is supported by a number of observations, including the seasonal distribution of the occurrence of SIDS, with peaks during the cold season; 22 the high incidence of concurrent upper respiratory tract infections among infants dying as a result of SIDS; 23 the peak age at 3 to 4 months, when immunoglobulin G levels among infants reach a nadir, caused by decreases in the levels of passively acquired maternal antibodies and still-insufficient production of their own antibodies; 24 the association with nicotine use in a child's household, which predisposes children to respiratory infections such as otitis media; and the protective role of breastfeeding. 25,26 Not surprisingly, a number of different viruses and bacteria have been suggested as causative agents of SIDS, as summarized by Blackwell and Weir.…”

Section: Discussionmentioning

confidence: 99%

A Controlled Study of the Relationship BetweenBordetella pertussisInfections and Sudden Unexpected Deaths Among German Infants

Heininger¹,

Kleemann

Cherry

2004

Pediatrics

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ABSTRACT.Objective. This was a prospective, controlled, multicenter study to investigate the relationship between Bordetella pertussis infections and sudden unexpected deaths among German infants.Design. Between 1995 and 1997, all infants who died at 7 to 365 days of age and for whom autopsies were performed in 1 of 8 participating institutes of legal medicine were enrolled. During a standardized autopsy, nasopharyngeal specimens (NPSs) and tracheal specimens were obtained for polymerase chain reaction (PCR) assays to detect B pertussis. The oligonucleotide primers PTp1 and PTp2, which specifically amplify a 191-base pair DNA fragment of the pertussis toxin operon of B pertussis, were used. Two control subjects (matched according to residence, age, gender, and nationality) were enrolled for each case subject, via a network of pediatricians in private practice, and NPSs were obtained from those infants. Parents of case subjects and control subjects were asked to provide specific information on respiratory illnesses of the child, contact with a known case of pertussis, or close contact with a person with a cough illness during the 4 weeks before death or enrollment, as well as the child's pertussis immunization status. The pathologists performing the autopsies were unaware of the PCR results.Results. Enrolled were 254 infants (66% male) with sudden unexpected deaths and 441 matched control subjects. Autopsies according to protocol were performed for 234 of the case subjects (92%); a diagnosis of sudden infant death syndrome (SIDS) was made for 76%. For the remaining subjects, causes of death were respiratory or other infections (14%), congenital anomalies or organ failures (4%), aspiration (2%), or accidents or traumatic events (4%). PCR results were positive for B pertussis for 12 case subjects (5.1%) (all with SIDS or respiratory infections) and 5.3% of control subjects. Of the 12 case subjects with positive PCR results, 10 (83%) were male. Questionnaires had been returned by the parents of 5 of the 12 infants. Three had experienced a respiratory illness (all with cough), beginning 7, 14, and 19 days before death. None had a known contact with a case of pertussis. Four of 15 control infants (27%) with positive PCR findings for B pertussis had a cough illness, indicating possible pertussis, and 2 of those 4 developed typical symptoms (whooping). Background information was received from 116 parents (46%) of case subjects and from parents of all control subjects. Upper respiratory tract infections within 4 weeks before death were reported for 53% of case subjects and 38% of control subjects. Also, fewer case subjects (33%) than control subjects (68%) had received age-adequate numbers of pertussis vaccine doses.Conclusions. The concept of infection as a factor in SIDS is supported by a number of observations, including the seasonal distribution of the occurrence of SIDS; the high incidence of concurrent upper respiratory tract infections among infants dying as a result of SIDS; the peak age at 3 to 4 months; nicotin...

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Infections of the upper respiratory tract in cases of sudden infant death

Cited by 27 publications

References 21 publications

Intra-alveolar haemorrhage in sudden infant death syndrome: a cause for concern?

Intra-alveolar haemorrhage in sudden infant death syndrome: a cause for concern?

Reaction patterns in selected lymphatic tissues associated with sudden infant death (SID)

A Controlled Study of the Relationship BetweenBordetella pertussisInfections and Sudden Unexpected Deaths Among German Infants

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